Department(s)/Institutions

Introduction

Glucocorticoids(GCS) remain the gold standard for treating an acute flare of IBD & response rates are often unpredictable.Resistance rates have been estimated to range from 20-30%,however predictive factors associated with GCS resistance remain uncertain.

Aims/Background

Method

A retrospective review of patients from HIPE Data requiring hospitalisation for an acute flare of colitis from 2010-2015 was undertaken.Demographics& clinical details including phenotype,behaviour,severity,duration,therapies,CRP,length of stay(LOS) were recorded. Resistance rates were determined by a lack of improvement or deterioration in day 3 CRP or need for therapy escalation or surgery. Steroid dependence was defined as relapse of symptoms within 3 months of stopping IV GCS. Results were compared amongst responders&non-responders using a student t-test&p value of <0.05 was considered significant.

Results

In all 473 patients requiring hospitalisation for acute colitis were identified,of which 247 have been analysed to date. A total of 74(29%)excluded due to insufficient information.Of the remaining 173,99 (57%) were female,mean age was 39yrs(15-84yrs),mean disease duration was 4.5yrs(0-27yrs).There were statistically more patients with Crohn's disease(CD) 98(57%)than UC 75(43%),p=0.009,95%CI0.03-0.24. In all 52(30%) had severe,87 moderate (50%),36 mild(20%) disease. Overall mean LOS was 10 days(3-49) and admission CRP 59 mg/l(1-307.9mg/l). Mean day 3 CRP was 25mg/l(1-260mg/l). In all,103(60%) were responders,55(31%) were steroid resistant &15(9%) were steroid dependent. Overall resistant patients had more severe disease vs responders 25(45%) vs 17(17%),p<0.0001,OR 4.2,95%CI 2.00-8.86. Mean CRP on day 3 for responders and non-responders was 10mg/l vs 48mg/l. CRP >45mg/l on day 3 appeared to be predictive of steroid resistance,OR 20.6,95% CI5.78-73.37,p<0.001. Overall disease subtype,concomitant therapies or disease extent did not appear to influence resistance rates,however amongst UC patients pancolitic patients had higher resistance rates,n=21(28%) vs. n=8(7%),p<0.0001,95%CI 0.18-0.42.In all 44(80%) of the resistant patients required surgical intervention,of which 13 (30%) had failed rescue biologic therapy.

Conclusions

GCS resistance rates in our cohort are similar to previously published figures&significant at 31%. A high CRP on day 3,severe disease& pancolitis are predictive of GCS resistance. Further work on mechanisms of steroid resistance is needed as most required surgery and did not respond to a biologic.